RESUMEN
AIMS: This study estimates the prevalence of chlamydia infection amongst teenage substance users aged 14-18years and investigates risk factors associated with a positive diagnosis of chlamydia infection. METHODS: Data was collected from the medical files of adolescents who attended a statewide drug and alcohol treatment facility during a three-year period commencing June 2011. RESULTS: The highest rate of chlamydia detection (18.0%) was found in the group with a reported history of abuse, a non-substance use psychiatric diagnosis, and individuals who did not complete year 10 education. CONCLUSION: Adolescents attending a detoxification facility are a suitable group for targeted chlamydia infection screening and early treatment.
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Infecciones por Chlamydia/epidemiología , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/complicaciones , Adolescente , Australia/epidemiología , Intervención Médica Temprana , Femenino , Humanos , Masculino , Prevalencia , Factores de RiesgoRESUMEN
This study examines how often depression and anxiety, in patients with diabetes, are detected by health professionals; and whether detection is influenced by patient characteristics (age, gender), illness factors (duration of illness, diabetes control), and self-reported levels of depression and anxiety. Prevalence rates of clinically significant depression and anxiety were high (57% and 36%, respectively); however, of those identified, only 44 and 36 per cent, respectively, were detected by staff as depressed or anxious. The only significant predictors of detection were severity of depressive and anxious symptoms. Patient and illness characteristics did not influence whether professionals identified emotional problems in their patients.
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Ansiedad/diagnóstico , Depresión/diagnóstico , Diabetes Mellitus/psicología , Personal de Salud , Adulto , Anciano , Ansiedad/epidemiología , Australia/epidemiología , Depresión/epidemiología , Trastorno Depresivo , Femenino , Conductas Relacionadas con la Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care. METHODS/DESIGN: In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol. DISCUSSION: This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.
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Desarrollo Infantil/fisiología , Desarrollo Fetal/fisiología , Inundaciones , Complicaciones del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adulto , Niño , Preescolar , Desastres , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Embarazo , Complicaciones del Embarazo/psicología , Resultado del Embarazo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Efectos Tardíos de la Exposición Prenatal/psicología , Estudios Prospectivos , Queensland , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Estrés PsicológicoRESUMEN
OBJECTIVE: This study investigates if the routine use of the urine drug screen offers any diagnostic or management benefit in the assessment and treatment of psychiatry patients in a suburban psychiatry emergency service. METHODS: Data was collected retrospectively from consecutive patients 18 years and above, who presented to a large suburban hospital emergency department and had a urine drug screen ordered in the emergency department. A total of 111 patients, (with mean age of participants being 34.9 years, SD 10.2 years, minimum 18-maximum 62 years, 62.2% (69/111) were male) met the inclusion criteria. RESULTS: The most common drug group identified was benzodiazepines (59.5%; 66/111), followed by cannabis (40.5%; 45/111). Other drugs were identified at much lower levels, including amphetamines (9.0%; 10/111), opiates (4.5%; 5/111) and methadone (0%; 0/111). For most individuals only one drug was detected (55.9%; 62/111), with equal numbers (18.9%) with either zero or two drugs identified by a urine drug screen. Fewer patients had three drugs on a urine drug screen (5.4%; 6/111) or four (0.9%; 1/111). CONCLUSIONS: Qualitative urine drug screens provide limited additional information compared to history taking and has minimal impact on clinical management decisions in a psychiatry emergency service.
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Servicios de Urgencia Psiquiátrica/métodos , Psicotrópicos/orina , Detección de Abuso de Sustancias/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
This study investigated parents' satisfaction with postdisaster school-based screening and whether satisfaction was related to follow-through with screening recommendations. From among 1,268 there were 224 children, ages 7-18 years (M = 10.97, SD = 2.44 years) screened for emotional distress 4 months after a flood and 130 parents who completed the screening evaluation. Of the 44 children who showed severe emotional distress, less than 50% of their parents reported concerns and only 29.5% had sought assistance. Following screening, 86.7% of these children completed treatment. Overall satisfaction ratings by parents were high, with 99.2% very or mostly satisfied.
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Síntomas Afectivos/diagnóstico , Desastres , Trastornos Mentales/diagnóstico , Servicios de Salud Mental/normas , Padres/psicología , Servicios de Salud Escolar/normas , Adolescente , Síntomas Afectivos/terapia , Niño , Comportamiento del Consumidor/estadística & datos numéricos , Femenino , Inundaciones , Humanos , Masculino , Trastornos Mentales/terapia , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions. OBJECTIVE: To critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model. METHOD: A narrative review of traditional CAMHS is presented. Important elements of a disaster response - individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach. RESULTS: Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy. CONCLUSION: In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
RESUMEN
OBJECTIVES: To assess the population prevalence of property, income and emotional impacts of the 2010-2011 Queensland floods and cyclones. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional telephone-based survey using a brief trauma exposure and impact screening instrument, conducted between 11 March and 6 June 2011, of 6104 adults who answered natural disaster and mental health questions. MAIN OUTCOME MEASURES: Natural disaster property damage exposure and emotional wellbeing impacts. RESULTS: Two-thirds of respondents (62%) reported being affected by the disasters, with property damage exposure ranging from 37.2% (suburb or local area) to 9.2% (own home, with 2.1% living elsewhere at least temporarily). Income was reduced for 17.0% of respondents and 11.7% of income-producing property owners reported damage to those properties. Trauma impacts ranged from 14.3% of respondents feeling "terrified, helpless or hopeless" to 3.9% thinking they might be "badly injured or die". Up to 5 months after the disasters, 7.1% of respondents were "still distressed" and 8.6% were "worried about how they would manage". Adults of working age and residents of regional and remote areas and of socioeconomically disadvantaged areas were disproportionately likely to report exposure to damage and emotional impacts. CONCLUSIONS: Weather-related disasters exact a large toll on the population through property damage and resultant emotional effects. Vulnerable subpopulations are more severely affected. There is a need for realistic, cost-effective and rapid-deployment mass interventions in the event of weather disasters.
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Tormentas Ciclónicas/economía , Tormentas Ciclónicas/estadística & datos numéricos , Desastres/economía , Desastres/estadística & datos numéricos , Inundaciones/economía , Inundaciones/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Vivienda/economía , Vivienda/estadística & datos numéricos , Humanos , Renta , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Propiedad/economía , Propiedad/estadística & datos numéricos , Queensland , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Trastornos por Estrés Postraumático/economía , Trastornos por Estrés Postraumático/epidemiología , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Increased understanding of the complex determinants of adverse child mental health outcomes following acute stress such as natural disasters has led to a resurgence of interest in the role of parent psychopathology and parenting. The authors investigated whether family functioning in the post-disaster environment would be impaired relative to a non-exposed sample and potential correlates with family functioning such as disaster-related exposure and child posttraumatic mental health symptoms. METHODS: Three months after a category 5 tropical cyclone that impacted north Queensland Australia, school-based screening was undertaken to case identify children who may benefit from a mental health intervention. Along with obtaining informed consent, parents completed a measure of family functioning. RESULTS: Of 145 families of children aged 8 to 12 years, 28.3% met criteria for dysfunction on the Family Adjustment Device, double the frequency in a community sample. The dysfunction group was significantly more likely to have experienced more internalising (anxiety/depression) symptoms. However, in an adjusted logistic regression model this group were not more likely to have elevated disaster-related exposure nor did children in these families validate more PTSD symptoms. CONCLUSIONS: The implications of post-disaster discordant family functioning and possible different causal pathways for depressive and PTSD-related symptomatic responses to traumatic events are discussed.
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Desastres/estadística & datos numéricos , Salud de la Familia/estadística & datos numéricos , Familia/psicología , Adulto , Ansiedad/epidemiología , Australia/epidemiología , Niño , Tormentas Ciclónicas/estadística & datos numéricos , Depresión/epidemiología , Femenino , Humanos , Masculino , Responsabilidad Parental/psicología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Queensland/epidemiología , Trastornos por Estrés Postraumático/epidemiologíaRESUMEN
AIM: Medication adherence is poor in many young people with chronic illness. However, little research has examined medication adherence in clinic samples of young people receiving psychotropic medication, and whether factors such as disorder or drug type influence adherence. This study aimed to examine medication adherence in children and adolescents receiving psychotropic medication. METHODS: Young people receiving psychotropic medication and their caregivers were recruited from pharmacy and mental health services within a large metropolitan hospital. A brief cross-sectional survey examined medication history, missed doses within the previous week and other clinical information. Multiple regression analysis examined whether child characteristics, drug type and regimen characteristics were associated with medication adherence. RESULTS: Poor adherence was associated with lack of parental involvement in medication routines (P < 0.05), use of complementary medicines (P < 0.01) and difficulty remembering doses (P < 0.01). Developmental diagnoses (P < 0.05), use of antipsychotics (P < 0.05) and use of concomitant non-psychotropic medication (P < 0.05) were predictors of good adherence. CONCLUSION: Encouraging parental involvement in medication routines may be a practical target for clinicians aiming to improve medication adherence in young people. Use of complementary medicines may indicate a group with a higher risk of poorer adherence.
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Cumplimiento de la Medicación , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Análisis de Regresión , Factores de RiesgoRESUMEN
INTRODUCTION AND AIMS: Gender differences have been reported in adult substance users, but little research has examined gender differences in adolescents presenting to treatment services. This study aimed to explore gender differences in adolescents presenting to a withdrawal service. DESIGN AND METHODS: All presentations to a withdrawal service between March 2000 and September 2004 were identified. For each presentation, the following information was extracted from clinical databases: sociodemographics, drug use, risk-taking behaviour, mental health symptoms, reasons and context of drug use. Significant gender differences identified at bivariate analysis were then incorporated into multivariate models exploring predictors of heroin use, cannabis use and sharing injecting equipment. RESULTS: A total of 262 young people were admitted during the study period (53% male, mean age 16.8 years; SD 1.13). Bivariate analysis indicated that girls were more likely to report: being homeless, using a greater number of substances, using heroin and amphetamines, higher rates of injecting, sharing injecting equipment and using with a partner. Multivariate analysis identified that being female was an independent predictor of heroin use and that being male was an independent predictor of cannabis use. Significant predictors of sharing injecting equipment were using with a partner and current use of heroin; the effect of gender was not significant after controlling for other factors. DISCUSSION AND CONCLUSIONS: Our findings indicate that male and female adolescents presenting to a withdrawal treatment service exhibit differences in substance use characteristics. Future research should examine the role of gender in determining optimal treatment approaches in substance-using adolescents.
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Conducta del Adolescente , Aceptación de la Atención de Salud/psicología , Caracteres Sexuales , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Adolescente , Australia , Femenino , Humanos , Masculino , Factores de Riesgo , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/psicologíaRESUMEN
OBJECTIVE: The aim of the present study was to investigate whether parent report of family resilience predicted children's disaster-induced post-traumatic stress disorder (PTSD) and general emotional symptoms, independent of a broad range of variables including event-related factors, previous child mental illness and social connectedness. METHODS: A total of 568 children (mean age = 10.2 years, SD = 1.3) who attended public primary schools, were screened 3 months after Cyclone Larry devastated the Innisfail region of North Queensland. Measures included parent report on the Family Resilience Measure and Strengths and Difficulties Questionnaire (SDQ)-emotional subscale and child report on the PTSD Reaction Index, measures of event exposure and social connectedness. RESULTS: Sixty-four students (11.3%) were in the severe-very severe PTSD category and 53 families (28.6%) scored in the poor family resilience range. A lower family resilience score was associated with child emotional problems on the SDQ and longer duration of previous child mental health difficulties, but not disaster-induced child PTSD or child threat perception on either bivariate analysis, or as a main or moderator variable on multivariate analysis (main effect: adjusted odds ratio (OR(adj)) = 0.57, 95% confidence interval (CI) = 0.13-2.44). Similarly, previous mental illness was not a significant predictor of child PTSD in the multivariate model (OR(adj) = 0.75, 95%CI = 0.16-3.61). CONCLUSION: In this post-disaster sample children with existing mental health problems and those of low-resilience families were not at elevated risk of PTSD. The possibility that the aetiological model of disaster-induced child PTSD may differ from usual child and adolescent conceptualizations is discussed.
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Desastres , Familia/psicología , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Poblaciones Vulnerables/estadística & datos numéricos , Niño , Comorbilidad , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Nueva Zelanda/epidemiología , Variaciones Dependientes del Observador , Padres , Prevalencia , Trastornos por Estrés Postraumático/diagnóstico , Factores de TiempoRESUMEN
BACKGROUND: Early pregnancy loss has been linked to enduring psychological morbidity. AIMS: This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. METHOD: Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. MAIN OUTCOME MEASURES: K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. RESULTS: A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. CONCLUSIONS: The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage.
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Aborto Espontáneo/psicología , Estrés Psicológico/diagnóstico , Encuestas y Cuestionarios , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Prevalencia , Curva ROC , Estrés Psicológico/epidemiología , Adulto JovenRESUMEN
Aggression is common in mental health services, but little research has examined exposure to aggression and its impact on staff in children and adolescent settings. Staff members within a child and adolescent psychiatric inpatient unit were interviewed to examine exposure to aggression and perceptions about the impact of aggression. Involvement in episodes of physical aggression was common (84.8%, 28/33) and was linked to difficulty attending work and other emotional and professional sequelae. These findings suggest that aggression is an important issue for staff working in child and adolescent settings and that aggression may impair the therapeutic capacity of staff.
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Agresión , Actitud del Personal de Salud , Pacientes Internos , Personal de Enfermería en Hospital/psicología , Exposición Profesional , Enfermería Psiquiátrica , Adolescente , Psiquiatría del Adolescente , Adulto , Agresión/psicología , Australia , Distribución de Chi-Cuadrado , Niño , Psiquiatría Infantil , Preescolar , Estudios Transversales , Femenino , Unidades Hospitalarias , Humanos , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/organización & administración , Exposición Profesional/efectos adversos , Exposición Profesional/estadística & datos numéricos , Admisión del Paciente , Enfermería Psiquiátrica/organización & administración , Encuestas y CuestionariosRESUMEN
A simple, rapid, selective, accurate and precise method is described for the determination of risperidone and its active metabolite, 9-hydroxyrisperidone, in plasma using a chemical derivative of risperidone (methyl-risperidone) as the internal standard. The sample workup involved a single-step extraction of 1 mL plasma, buffered to pH 10, with heptane-isoamyl alcohol (98:2 v/v), then evaporation of the heptane phase and reconstitution of the residue in mobile phase. HPLC separation was carried out at on C(18) column using a mobile phase of 0.05 m dipotassium hydrogen orthophosphate (containing 0.3% v/v triethylamine) adjusted to pH 3.7 with orthophosphoric acid (700 mL), and acetonitrile (300 mL). Flow rate was 0.6 mL/min and the detection wavelength was 280 nm. Retention times were 2.6, 3.7 and 5.8 min for 9-hydroxy risperidone, risperidone and the internal standard, respectively. Linearity in spiked plasma was demonstrated from 2 to 100 ng/mL for both risperidone and 9-hydroxyrisperidone (r > or = 0.999). Total imprecision was less than 13% (determined as co-efficient of variation) and the inaccuracy was less than 12% at spiked concentrations of 5 and 80 ng/mL. The limit of detection, determined as three times the baseline noise, was 1.5 ng/mL. Clinical application of the assay was demonstrated for analysis of post-dose (0.55-4.0 mg/day) samples from 28 paediatric patients (aged 6.9-17.9 years) who were taking risperidone orally for behavioural and emotional disorders.
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Antipsicóticos/sangre , Cromatografía Líquida de Alta Presión/métodos , Isoxazoles/sangre , Trastornos Mentales/sangre , Pirimidinas/sangre , Risperidona/sangre , Adolescente , Antipsicóticos/uso terapéutico , Niño , Femenino , Humanos , Isoxazoles/uso terapéutico , Modelos Lineales , Masculino , Trastornos Mentales/tratamiento farmacológico , Palmitato de Paliperidona , Pirimidinas/uso terapéutico , Reproducibilidad de los Resultados , Risperidona/uso terapéutico , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: The primary purpose of the present study was to examine changes in utilization of pro re nata (PRN; 'as required') sedation over time within a child and adolescent psychiatric inpatient unit. The secondary purpose was to assess whether changes in PRN sedation were related to changing patient characteristics. METHODS: A retrospective chart review examined 257 medical charts from a child and youth mental health inpatient service over two time periods (wave I, n = 122; wave II, n = 135) and collected data on PRN sedation, patient characteristics and routine medications. RESULTS: Over time a significant reduction was observed in the proportion of patients prescribed PRN sedation from 70% to 54% (p < 0.01), and a reduction in the proportion of patients given PRN sedation from 46% to 26% (p < 0.01). The most commonly administered drug was chlorpromazine in wave I, and diazepam in wave II. Multivariate analysis indicated that reductions in PRN sedation occurred independently of changes in patient characteristics. CONCLUSIONS: High utilization rates of PRN sedation are not inevitable in a child and adolescent psychiatric inpatient unit and may be reduced over time. Changing utilization of PRN sedation occurred independently from changing patient characteristics. More treatment outcome studies are required to optimize use of PRN sedation in young people.
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Quimioterapia/estadística & datos numéricos , Hipnóticos y Sedantes/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Psiquiatría/métodos , Adolescente , Niño , Preescolar , Esquema de Medicación , Femenino , Hospitalización , Humanos , Masculino , Trastornos Mentales/rehabilitación , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVE: Parents often report their children display irregular eating patterns. Our aim is to describe the stability of maternal-perceived irregular eating of their offspring from 6 months to 2-4 years of age and to investigate factors that are associated with maternal perceived irregular eating of their 2-4 year old offspring. METHODS: A longitudinal mother-child linked analysis was carried out using 5 year follow-up data from a population-based prospective birth cohort of 5122 mothers who were participants in the Mater-University Study of Pregnancy, Brisbane. Measures included responses to standardized questionnaires, pediatrician review and standardized measures such as the Peabody Picture Vocabulary Test-Revised and the Child Behavior Checklist. RESULTS: 20.2% and 7.6% of mothers respectively stated their 2-4 year old was sometimes or often an irregular eater. Continuity of feeding difficulties from age 6 months was prominent: 48% of 6 month olds with a feeding problem were 'sometimes' or 'often' irregular eaters at age 2-4 years. From a multivariable analysis, both child-intrinsic factors (chronic physical morbidity, sleeplessness and anxiety-depressive symptoms) and factors that impinge upon the child (poor maternal health and maternal depression and anxiety) independently contributed to irregular eating status at age 2-4 years. CONCLUSIONS: We conclude that approximately one third of mothers had some concern with their child's irregular eating, 7.6% of mothers were often concerned. Irregular eating children were usually physically well, more likely to have persisting feeding problems, sleeplessness, behavioral problems and lived with mothers with perceived poor physical and mental health. Intervention strategies should be family orientated and include child, mother and mother-child psychosocial approaches.
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Actitud , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Madres/psicología , Medio Social , Factores de Edad , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/psicología , Trastornos de la Conducta Infantil/diagnóstico , Trastornos de la Conducta Infantil/epidemiología , Trastornos de la Conducta Infantil/psicología , Preescolar , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Depresión/psicología , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/epidemiología , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Relaciones Madre-Hijo , Queensland , Factores de Riesgo , Privación de Sueño/psicologíaRESUMEN
OBJECTIVE: Aggressive behaviour is common in young people admitted to child and adolescent inpatient services. Little is known about how physical aggression during admission influences patient outcomes. The aim of the present study was to identify predictors of aggression in a child and adolescent inpatient unit and examine differences in clinical outcomes between aggressive and non-aggressive patients. METHOD: Episodes of aggression occurring within a child and adolescent inpatient unit were prospectively documented between October 2004 and December 2005. Patient factors (demographics, diagnoses, clinical history) were examined as predictors of aggression. Outcomes for admissions in which more than one episode of physical aggression occurred were compared to those in which no aggression occurred. Outcomes assessed were changes in symptom severity (as rated by the Health of the Nation Outcome Scales for Children and Adolescents) length of stay, and initiation of medications. RESULTS: A total of 134 patients were admitted during the study period (61.9% female, mean age=13.8 years, SD=2.9); 31 patients (23.1%) exhibited physical aggression during admission and 20 of these exhibited more than one episode of physical aggression. Factors that predicted persistent physical aggression included history of aggression, use of medications at presentation and absence of self-harm. Persistent aggression was also associated with increased length of stay, but did not compromise improvements in clinical symptom ratings between admission and discharge or lead to increased medication prescribing. CONCLUSION: Contrary to hypotheses and existing research, aggression during admission does not appear to be a barrier to clinical improvement. Further research is necessary to clarify how aggressive children can receive the most benefit from inpatient admission while minimizing the risks to the patient and those around them.
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Agresión/psicología , Pacientes Internos/psicología , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Admisión del Paciente , Servicio de Psiquiatría en Hospital , Adolescente , Conducta del Adolescente/psicología , Niño , Conducta Infantil/psicología , Preescolar , Femenino , Humanos , Tiempo de Internación , Masculino , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: The objective of this study is to examine whether adolescents' measured BMI and self- or mother's perception of weight status at age 14 are associated with depression at age 21. RESEARCH METHODS AND PROCEDURES: The study participants were a subsample of 2017 participants of the Mater-University of Queensland Study of Pregnancy and Its Outcomes, a population-based birth cohort study, which commenced in 1981 in Brisbane, Australia, for whom measured BMI at ages 14 and 21 and information on self-reported mental health problems were available at the age 21 follow-up. A total of 1802 individuals had measured BMI and reported weight perception in a supplementary questionnaire at 14 years, and their self-reported mental health problems were reported at 21 years. Mental health was measured using Center for Epidemiology Studies Depression Scale and Young Adults Self-Reported depression/anxiety at 21 years of age. RESULTS: We found that both young adult males and females who perceived themselves as overweight at age 14 had more mental health problems compared with those who perceived themselves as the right weight. When we combined adolescents' weight perception with their measured BMI categories, weight perception but not measured overweight was associated with mental health problems for males and females at age 21. This association remained after adjusting for potential confounders, including adolescents' behavioral problems, family meals, diet, physical activity, and television watching. CONCLUSIONS: This study suggests that the perception of being overweight during adolescence is a significant risk factor for depression in young adult men and women. The perception of being overweight during adolescence should be considered a possible target for a prevention intervention.